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Insurance Claims

Purchasing all kinds of different forms of insurance to protect yourself and family from the financial costs associated with loss or damage to your home, personal property, health or life.Most often, if you suffer a loss for which you hold a valid contract of insurance, you are entitled to compensation or benefits as described in the policy.

Insurance claims are structured around an insurance policy and this policy is a contractual agreement that imposes obligations on both the insurer and the insured.The insurance settlement process can be frustrating & complex, not to mention time consuming.In all likelihood it’s probably the first time since signing the insurance contract, that you, the insured, have had any contact with your insurance provider.Typically, certain steps must be taken before your insurance company accepts or rejects your claim, furthermore there are specific timelines regarding when you are able to sue for recovery against your insurance provider.

Section 23 of British Columbia’s Insurance Act stipulates that in the case of property loss, a legal action must be started within two years after the date that the insured knew or should have known the loss occurred, and in all other insurance claims, within two years after the date the cause of action arose.

In most cases, this means that you have two years from the date of your insured loss to either resolve the claim with your insurer, or start a legal action against your insurance company.

As an insured, the typical obligations you have require you to pay your premiums, and in some cases, notify your insurance provider of any material changes to the things insured that will affect the insurance company’s risk. When a loss occurs, you have additional responsibilities.

You are required to provide proof and notice of your loss within a certain time period and failure to do so can negatively affect your claim.

You are also required to act in good faith by providing truthful information about your claim at all times.

Your insurance company has obligations as well. The person assigned to handle your claim must evaluate it and decide whether to accept or reject it. The insurer does this by assessing the evidence supplied and the insurance policy you signed.Often times the insurer solicits the help of an adjuster to conduct a full review of your claim. Your insurance provider is legally required to act in good faith and is required to make their insurance decisions on what is referred to as“reasonable grounds.” If the insurance company acts unreasonably or is found by a court to have acted in “bad faith,” you may be entitled to significant compensation that is over and above your insurance benefits and legal costs.

Some Examples of “Bad Faith”

Failure to properly investigate a claim

Making threats against an insured

Unreasonable delay in handling a claim

Unreasonably interpreting an insurance policy against an insured

There can at times be a power imbalance created between you, as the insured, and your insurance provider. Having experienced a loss, you are likely in a financially vulnerable position. The lawyers at MacIsaac & Company have years of experience negotiating with insurance providers assisting clients to receive fair compensation. Our lawyers have the knowledge and experience to handle all aspects of your claim and will help you gain a fair settlement through negotiation, mediation or trial.

Life Insurance

When you are a beneficiary collecting life insurance you may have problems with the insurance provider when making your claim.If you fail to disclose an accurate medical history to the insurer:

including prior medical conditions,

medical tests or examinations

other material fact that may affect eligibility for life insurance, and may operate to void the life insurance contract.

Our lawyers can advise you regarding the exceptions to this general rule.

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